Primary objective is to determine the response rate of gemcitabine plus paclitaxel combination therapy when given once every 2 weeks in patients with locally advanced or metastic, previously treated or chemonaive TCC of urothelium Seconday goals are toxicity assessment, changes in QOL, safety when given to patients with moderate renal insufficiency, and to characterize gemcitabine pharmacokinetics in 6 patients wiht moderate renal insufficiency and 6 patients with normal renal function.